Albuterol and ipratropium inhalation

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of albuterol and ipratropium can be fatal. Overdose symptoms may include chest pain, fast or pounding heartbeats, extreme thirst, muscle weakness or limp feeling, severe headache, buzzing in your ears, weak pulse, fainting, or slow breathing (breathing may stop).

If this medication gets in your eyes, rinse with water and seek medical attention.

This medication may cause blurred vision and may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert and able to see clearly.

Usual Adult Dose for Chronic Obstructive Pulmonary Disease -- Maintenance:

Combivent(R) inhalation aerosol: 2 inhalations 4 times a day
Patients may take additional inhalations as required; however, the total number of inhalations should not exceed 12 in 24 hours.

Combivent(R) Respimat(R) inhalation spray: 1 inhalation 4 times a day
Patients may take additional inhalations as required; however, the total number of inhalations should not exceed 6 in 24 hours.

DuoNeb(R) inhalation solution: One 3 mL vial by nebulization 4 times a day with up to 2 additional 3 mL doses allowed per day
The maximum recommended dose is 6 vials (18 mL)/day.

Applies to albuterol / ipratropium: inhalation aerosol liquid, inhalation aerosol powder, inhalation solution, inhalation spray

Along with its needed effects, albuterol / ipratropium may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking albuterol / ipratropium:

• Body aches or pain
• chills
• cough
• cough producing mucus
• difficulty with breathing
• ear congestion
• fever
• headache
• loss of voice
• runny nose
• sneezing
• sore throat
• stuffy nose
• tightness in the chest
• unusual tiredness or weakness

• Bladder pain
• bloody or cloudy urine
• blurred vision
• burning while urinating burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
• chest pain
• congestion
• diarrhea
• difficult, burning, or painful urination
• dizziness
• fainting
• fast, slow, irregular, pounding, or racing heartbeat or pulse
• frequent urge to urinate
• general feeling of discomfort or illness
• hoarseness
• increased sputum
• joint pain
• loss of appetite
• lower back or side pain
• muscle aches and pains
• nausea
• nervousness
• noisy breathing
• pain
• pain or tenderness around the eyes and cheekbones
• pounding in the ears
• shakiness in the legs, arms, hands, or feet
• shivering
• sweating
• swelling
• tender, swollen glands in the neck
• trembling or shaking of the hands or feet
• trouble sleeping
• trouble swallowing
• voice changes
• vomiting

• Skin rash or hives
• swelling of the face, lips, eyelids, mouth, or throat

• Chest discomfort
• decrease in the frequency of urination
• decrease in urine volume
• difficulty in passing urine (dribbling)
• itching skin
• large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
• pain or discomfort in the arms, jaw, back, or neck
• puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
• redness of the skin
• welts

Some side effects of albuterol / ipratropium may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

• Acid or sour stomach
• bad, unusual, or unpleasant (after) taste
• belching
• change in taste
• diarrhea
• difficulty with moving
• dry mouth
• heartburn
• indigestion
• muscle pain or stiffness
• stomach discomfort, upset, or pain
• voice changes

• Bigger, dilated, or enlarged pupils (black part of the eye)
• blindness
• change in near or distance vision
• decreased vision
• difficulty in focusing eyes
• dry throat
• eye pain
• increased sensitivity of the eyes to light
• itching, redness, tearing, or other sign of eye irritation not present before use of this medicine or becoming worse during use
• lack or loss of strength
• noisy breathing
• redness of the white part of the eyes or inside of the eyelids
• swelling of the eye
• swelling or inflammation of the mouth
• tearing

The manufacturer recommends caution when administering this drug to patients with hepatic insufficiency.

There are no data on the excretion of albuterol or ipratropium into human milk. The manufacturer recommends that due to the potential for serious adverse reactions in nursing infants, a decision should be made to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.